title: [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study].
abstract: BACKGROUND
  Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension.
  
  
  OBJECTIVE
  To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactobacillus plantarum (3.3 x 10(7) UFC), Streptococcus faecalis (3.3 x 10(7) UFC) and Bifidobacterium brevis (1.0 x 10(6) UFC) (Bioflora) and 5 ml bid were administered for 5 days. Both groups went on the same diet, which consisted in reduced consumption of alcohol, legumes, dairy products and leafy green vegetables. Response to treatment was assessed by an independent questioner 15 days post treatment. A five-level overall response questionnaire was used. Responses included much better, better, the same, worse, and much worse. Better and much better were considered positive responses.
  
  
  RESULTS
  Thirteen (52%) subjects receiving metronidazol and 20 (82%) receiving the probiotic referred clinical improvement after the treatment. A statistically significant difference favoured the use of the probiotic (P = 0.036). All the study patients completed treatment. No adverse events leading to treatment discontinuation were observed.
  
  
  CONCLUSIONS
  Based on this pilot study results, we can suggest that the probiotic herein used has a higher efficacy than metronidazol in the early clinical response of patients with chronic abdominal distension and SIBO.
authors.affiliation: Department of Medicine, Gastroenterology Division, Center for Medical Education and Clinical Research Norberto Quirno, CEMIC, CEMIC University Institute, IUC Ciudad de Buenos Aires, Argentina. luisosoifer@fibertel.com.ar
authors.forename: Luis Oscar
authors.initials: LO
authors.lastname: Soifer
authors.forename: Daniel
authors.initials: D
authors.lastname: Peralta
authors.forename: Guillermo
authors.initials: G
authors.lastname: Dima
authors.forename: Horacio
authors.initials: H
authors.lastname: Besasso
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002908:Chronic Disease; D005260:Female; D013271:Gastric Dilatation / Q000188:drug therapy*; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole